On the day of your Step Up Together Drill, whether you’ve planned a Partial Transfer or Full Transfer Drill, the fidelity of the clinical scenario rests largely on the acting of the patient. This role should be held by someone who is very familiar with community birth, such as a midwife or student midwife, nurse or birth assistant, or doula; or perhaps even an administrator or other non-clinical staff member who has personal experience with community birth.
The Person Playing the Patient Should Have Personal Experience with Community Birth
Someone who holds this deep familiarity with community birth will understand that labor and birth in the community setting is nothing like the movies. In an intrapartum drill, the first contraction after the Drill Coordinator says “Let’s Begin” can be sacredly quiet while the midwife, doula and partner all bear witness to the undisturbed labor. This offers a rarely-seen insider’s view into community birth that your collaborating teams from EMS and the hospital may never have understood before now. It also sets the tone for a calm, patient-centered approach to managing perinatal emergencies.
Understanding the Entire Drill Scenario is Crucial
It is crucial for the person playing the Patient to understand the entire drill scenario before it begins so that they can act out the scene in a way that aligns with the prompts. The Drill Coordinator should meet with the Patient in advance so that they have a chance to read through the scenario and prompts, and ask questions beforehand. This can occur during the planning and logistics process, but should certainly at least occur on the day of the drill itself. Clarify with them whether they will or will not be birthing before transport; or whether they could be transferred separately from their newborn. Reassure them you will prompt them whenever a contraction begins or ends, or with the sensations they might be expressing in the scenario. Remind them that attending this drill may be the first time some of their collaborating colleagues have the opportunity to see a small snapshot of community care, and they should draw from their experience to make it as realistic as possible!
Encourage the Feedback of the Patient Role
As the debrief begins, emphasize to the full group that performing interdisciplinary drills is crucial to improving patient outcomes and experiences. Therefore, be sure to highlight the feedback elicited from the person in the role of the patient during your debrief, as their experience is very unique and they will have important insight into the care they received and the systems in place during each phase of care. They should be made to feel that they can share both positives and challenges freely. They may also need special aftercare (along with the rest of the performers in the drill), since their nervous system will have been activated throughout the drill. We have heard from past participants that being the Patient can be “intense but rewarding”, and that midwives who act as the Patient find even deeper clarity in the way they provide community based care.
Much appreciation to everyone who holds this highly important role!
Key Takeaways:
- The role of the patient should be played by someone who has experience with community birth
- The patient should have a complete understanding of the drill prompts and clinical scenario to help them stay aligned with the the drill as it unfolds
- Ensure adequate time during the debrief to elicit input from your drill patient, as this is a key perspective for quality improvement
